Annals of breast surgery : an open access journal to bridge breast surgeons across the world最新文献

{"title":"Narrative review of breast reconstruction with a latissimus dorsi flap—is there a price to pay?","authors":"Jens H. Højvig, C. Bonde","doi":"10.21037/abs-21-30","DOIUrl":"https://doi.org/10.21037/abs-21-30","url":null,"abstract":": The musculocutaneous latissimus dorsi flap is a stable workhorse in reconstructive plastic surgery. It is commonly used as a safe and viable alternative to the DIEP flap and possesses the advantage that it does not require microsurgical expertise. It offers a natural and aesthetically satisfying result, the complications rates are generally low and the postoperative length of hospitalization is short. Although investigated numerous times through the past decades, the functional effect of raising a latissimus dorsi flap remain debatable. We performed a review of the literature and identified studies that have investigated the functional effects after breast reconstruction with a m. latissimus dorsi flap. A reduction in shoulder strength for motions to which the muscle contributes could be intuitively expected following its dissection and have been reported by some authors. However, range of shoulder motion is unaffected in most studies and the subjective effect of the procedure on shoulder function remains ambiguously reported. The following article presents an overview of functional outcomes such as range of motion, shoulder strength and patient reported ability to perform activities of daily living following breast reconstruction with a latissimus dorsi flap. We also discuss other important factors regarding the outcome after m. latissimus dorsi flap, that should ideally be considered, when choosing and informing the patients about strategy for breast reconstruction.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44606403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast cancer in the older population: a global challenge—an epidemiological perspective","authors":"A. Lemij, E. Bastiaannet, N. D. de Glas, F. van den Bos, J. Portielje, G. Liefers, M. Derks","doi":"10.21037/abs-21-89","DOIUrl":"https://doi.org/10.21037/abs-21-89","url":null,"abstract":"Breast cancer is the most commonly diagnosed malignancy among women, with more than 30% of all patients being over 70 years at the time of diagnosis. The number of older women with breast cancer is expected to increase in the upcoming decades due to the ageing of the population worldwide. Incidence and mortality rates vary between and within continents because of variances in risk factors, health care quality and screening programmes. In older patients, breast cancer occurs to the background of ageing. Ageing increases the exposure to age-related diseases resulting in a heterogeneous population with large differences in multimorbidity. Multimorbidity is associated with mortality, functional impairment, poor quality of life, high health care utilization and costs, and it challenges traditional health care systems. It is therefore essential to get a grip on an individual’s fitness and frailty status. Geriatric screening tools and assessments should be used to get a general idea about these aspects. In that way, biological age, rather than chronological age, in combination with an individual’s life expectancy, patient preferences and potential side effects of a treatment can be the basis of individualized treatment strategies. Nowadays, this heterogeneous older population is underrepresented in clinical trials. Future research should focus on older patients with relevant endpoints, not only in developed countries, but also in less developed countries.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47938617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensory reinnervation after mastectomy with implant-based reconstruction","authors":"A. Peled, Z. Peled","doi":"10.21037/abs-21-9","DOIUrl":"https://doi.org/10.21037/abs-21-9","url":null,"abstract":"As breast cancer therapies continue to improve, increasing focus has been placed on quality-oflife issues after breast cancer and breast cancer risk-reducing treatments. The loss of sensation that typically occurs after mastectomy can have significant negative psychological, sexual, and functional impact on patients after surgery. In order to minimize this impact, more recent attention has been paid to ways to both avoid nerve injury at the time of mastectomy and reconstruct injured nerves either during mastectomy or at the time of delayed reconstruction. These advances have been facilitated by anatomic studies investigating different variants of intercostal anatomy and better understanding the course of the nerves innervating the mastectomy skin and nipple-areolar complex. With improved knowledge of the intercostal nerve anatomy, surgeons are able to carefully preserve nerves at the time of mastectomy, thus improving sensory outcomes. Additionally, nerve reconstruction techniques have advanced, particularly with newer nerve allograft technologies, which allows for nerve reconstruction to be done both at the time of mastectomy, as well as in a delayed fashion. Much of the current literature on intercostal nerve reconstruction to improve postmastectomy sensation has been performed in the setting of autologous reconstruction, but several more recent studies have assessed outcomes following implant-based reconstruction. The focus of this article is to describe the current state of sensory preservation and reinnervation for mastectomy with implant-based reconstruction and the advances that have allowed for these new approaches.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44253783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Negative predictive value and specificity of contrast enhanced spectral mammography in 309 women with suspicious findings at breast ultrasound","authors":"T. Emory, N. Hoven, Michael Nelson, A. Church, N. Rubin, J. Kuehn-Hajder","doi":"10.21037/ABS-20-91","DOIUrl":"https://doi.org/10.21037/ABS-20-91","url":null,"abstract":"Background: There are ongoing efforts to discover readily available noninvasive techniques to accurately exclude the presence of cancer when a suspicious breast lesion is identified. In order to be useful, such a technique must also accurately exclude a sizeable number of women who would have been otherwise biopsied. Therefore, such a test should have a high negative predictive value in excluding malignancy and a high enough specificity in predicting which women will turn out to have a benign biopsy result. The goal of this study was to investigate the negative predictive value and specificity of contrast enhanced spectral mammography (CESM) in women with a suspicious finding on diagnostic mammography and ultrasound. Methods: With IRB approval, CESM reports from two academic breast centers were retrospectively evaluated. Four hundred and twenty-four women were identified, and 309 women met inclusion criteria. All women had a suspicious finding on diagnostic mammography and ultrasound and had CESM prior to a same day scheduled ultrasound guided core needle biopsy. Results: Two hundred/309 (65%) women had histologically proven malignancy and 109/309 (35%) women had benign results. One hundred and ninety-seven/200 cancers enhanced at CESM [sensitivity 98.5%; 95% confidence interval (CI): 95.7–99.7%]. Fifty-eight/109 women with benign results did not enhance and were true negatives (specificity 53.2%; 95% CI: 43.4–62.8%). Of the 248 women with CESM lesion enhancement, 197/248 were cancer (positive predictive value =79.4%; 95% CI: 76.0–82.5%). Of the 61 women without lesion enhancement on CESM, 58/61 were benign (negative predictive value =95.1%; 95% CI: 86.1–98.4%). The 3 false negatives consisted of 2 sub centimeter Nottingham grade 1/3 estrogen receptor (ER) positive HER2/neu negative invasive mammary cancers of no special type, and one case of ductal carcinoma in situ (DCIS) in a papilloma which was 3 mm in size at excision. Conclusions: CESM was accurate in excluding malignancy in over half of the women that had otherwise suspicious findings at diagnostic mammography and ultrasound. 12 fibrocystic changes, 5 of 8 papillomas, 1 of 8 stromal fibrosis, and 4 of 7 sclerosing adenosis results.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46116144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast reconstruction—the true multidisciplinary approach","authors":"T. Damsgaard, J. Thomsen","doi":"10.21037/abs-21-28","DOIUrl":"https://doi.org/10.21037/abs-21-28","url":null,"abstract":"","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47339473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transaxillary endoscopic breast reconstruction: case series from single institution","authors":"E. Esposito, U. Marone, R. Saponara, E. Morra, G. Di Monta, M. Rho, F. Avino, S. Mori","doi":"10.21037/abs-21-143","DOIUrl":"https://doi.org/10.21037/abs-21-143","url":null,"abstract":"","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46029836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of mammography and magnetic resonance imaging to diagnose underlying malignancy in Paget’s disease of the nipple: a systematic review and meta-analysis","authors":"Karen-Lise Madsen, Anne D. H. Mosebo, S. Möller, B. H. Pedersen, C. Bille","doi":"10.21037/abs-21-95","DOIUrl":"https://doi.org/10.21037/abs-21-95","url":null,"abstract":"","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42534593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postmastectomy radiation: an evolution","authors":"Brianna M. Jones, V. Osborn","doi":"10.21037/ABS-20-120","DOIUrl":"https://doi.org/10.21037/ABS-20-120","url":null,"abstract":": Postmastectomy radiation therapy (PMRT) has long been utilized to improve locoregional control versus surgery alone, and recent decades have revealed a survival benefit for many higher risk patients based on tumor or nodal factors. During this time the landscape of cancer treatment has evolved towards less invasive surgeries and more effective chemotherapy—likewise, more precise methods of delivering radiation therapy have also emerged, drastically reducing the risk for significant side effects compared with cruder historical techniques. This paper will discuss modern era radiation techniques, toxicity profile, and reconstructive options. Several recent studies have demonstrated improved locoregional control and overall survival in patients whom received postmastectomy radiation. This review will pay special attention to utility of radiation after mastectomy in patients with positive nodes and negative nodes with high-risk features. The indications for radiation therapy after mastectomy have broadened over the past few decades and this review article hopes to explore evolving evidence, as well as, new considerations in setting of increasing use of neoadjuvant chemotherapy and trend towards shorter course radiation treatment. Future directions and ongoing trials exploring benefit of additional radiation and omission of radiation will also be discussed. While some questions remain unanswered on exactly who is likely to benefit, anyone with a large tumor, nodal involvement or other high-risk features should be considered for evaluation.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42058304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alternative flaps for breast reconstruction: a narrative review on using the thigh, buttocks, and back","authors":"Chaoqing Zhou, R. R. van der Hulst","doi":"10.21037/abs-21-8","DOIUrl":"https://doi.org/10.21037/abs-21-8","url":null,"abstract":"As the treatment of breast cancer has dramatically improved in the past decades, so have the techniques for breast reconstruction. Recent innovations in breast implants and the advent of acellular dermal matrices have expanded options for reconstructive surgeons, allowing for cosmetic results previously unattainable in selected cases. However, autologous reconstructive techniques using free flaps remain to provide results that are unparalleled in terms of durability and feel. In this narrative review, the authors share their current experience with free flaps for breast reconstruction harvested from regions other than the abdomen. These include flaps that can be harvested from the thigh, buttocks, and back regions such as upper gracilis myocutaneous flaps, the profunda artery perforator flap, the lateral thigh perforator (LTP) flap, gluteal artery perforator flaps, and the lumbar artery perforator flap. The aim of this article is to improve readers’ understanding of the advantages and caveats of each flap, patient selection, and key surgical points. For those interested in learning to perform any of these flaps, a 10-step summary is provided which describes our personal technique in flap harvesting in more detail. Furthermore, knowledge gaps that exist about the clinical outcomes of each technique and future research implications are also highlighted.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47899800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the time to adjuvant treatment following immediate breast reconstruction in breast cancer patients","authors":"Edward Antram, E. Shaari, R. Balasubramanian, B. in‘t Hout, T. Kovács, H. Hamed, A. Kothari","doi":"10.21037/abs-21-37","DOIUrl":"https://doi.org/10.21037/abs-21-37","url":null,"abstract":"","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45388637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}